Hay fever, also known as seasonal allergic rhinitis, is a very common allergy that can make the warmer months extremely uncomfortable. For some people, symptoms can be mild and manageable, while for others hay fever can have a major impact on sleep, work, school, exercise and everyday life. With the warm, dry and sometimes windy weather we can experience during the summer, hay fever can become particularly troublesome. Weather conditions have a significant effect on pollen: temperature, sunshine, rainfall and wind all influence how much pollen is produced and how easily it spreads through the air. The Met Office notes that warm, dry conditions with a breeze can produce high grass-pollen levels, while wind can disperse pollen over wider areas. What causes hay fever? Hay fever occurs when the immune system reacts to pollen as though it were a harmful substance. The body releases chemicals including histamine, resulting in the familiar symptoms of an allergic reaction. The main causes are:

• Grass pollen – one of the most common causes of hay fever in the UK.
• Tree pollen – particularly important during spring.
• Weed and plant pollen – can affect people later in the summer and into autumn.
• Mould spores – these can also trigger allergic rhinitis in some people.
• Weather conditions – warm, dry and windy weather can help pollen become airborne and spread, potentially making symptoms worse.
• Family history – people with a family history of allergies may be more likely to develop hay fever.
• Other allergic conditions – hay fever is more common in people who also have conditions such as asthma or eczema.

The UK pollen season is not restricted to spring. Tree pollen generally appears first, grass pollen is particularly important from late spring into summer, and weed pollen can continue into September. Why can hay fever be so bad with the weather? Weather can make a noticeable difference to hay fever symptoms. Warm weather can encourage pollen release, while dry conditions allow pollen to remain airborne. Wind can carry pollen over considerable distances. Rain can temporarily reduce pollen concentrations in the air, although rainfall can also encourage plant growth, potentially contributing to more pollen later when conditions become dry again. This means that when conditions are warm, dry and breezy, people who are sensitive to pollen may notice a significant increase in sneezing, itchy eyes, blocked noses and other symptoms. Common symptoms of hay fever Hay fever can affect the nose, eyes, throat and general wellbeing. Common symptoms include:

• Frequent sneezing
• Runny or blocked nose
• Itchy nose, throat, mouth or ears
• Red, itchy or watery eyes
• Coughing
• Loss of smell
• Headaches or facial pressure
• Tiredness and poor sleep

People who have asthma may also find that their asthma symptoms become worse during periods when their hay fever is troublesome. Unlike a common cold, hay fever can continue for weeks or months, depending on which pollen someone is allergic to and how long they are exposed to it. How is hay fever diagnosed? For many people, hay fever can be diagnosed from their symptoms and the time of year they occur. A GP or other healthcare professional may ask about:

• When symptoms started
• Whether symptoms occur during particular seasons
• Where symptoms are worse
• Exposure to grass, trees, plants or other potential allergens
• Family history of allergies
• Whether medicines have helped previously

It can also be useful to keep a symptom diary, noting when symptoms appear and whether they correspond with high pollen days. Most people do not need formal allergy testing. However, if symptoms are particularly severe, unusual, difficult to control, or the specific allergen is unclear, a GP may arrange allergy testing or refer someone to a specialist allergy clinic. Tests can include skin-prick testing or blood tests. Treating hay fever There is currently no simple cure for hay fever, but there are many effective ways of controlling the symptoms. Treatment can involve a combination of avoiding pollen exposure, pharmacy medicines, prescription treatments and, for selected patients with severe symptoms, specialist treatments. Antihistamines Antihistamines are one of the most commonly used treatments for hay fever. They work by blocking the effects of histamine, helping to reduce symptoms such as sneezing, itching and a runny nose. There are non-drowsy antihistamines, including medicines such as cetirizine, loratadine and fexofenadine, as well as older antihistamines that are more likely to cause drowsiness. The NHS advises that non-drowsy options are generally preferred when appropriate, although individual responses vary. A pharmacist can advise on which antihistamine may be appropriate, particularly for children, older people, people taking other medicines, or anyone with other medical conditions. Steroid nasal sprays Steroid nasal sprays are particularly useful when hay fever causes significant nasal inflammation, congestion, sneezing or a runny nose. They work by reducing inflammation inside the nose and are considered an important first-line treatment for allergic rhinitis. They generally need to be used correctly and regularly rather than only occasionally, and they can take time to reach their full effect. A pharmacist, GP or specialist can demonstrate the correct nasal-spray technique, which can make a significant difference to how well the treatment works. Eye drops For people whose main problem is itchy, red or watery eyes, appropriate allergy eye drops can provide additional relief. Depending on the individual situation, healthcare professionals may recommend antihistamine or other anti-allergy eye preparations. Nasal saline rinses Salt-water nasal sprays or rinses can help wash allergens and mucus from the nose and may be useful alongside other treatments. Decongestants Decongestant nasal sprays may provide short-term relief from a blocked nose, but they should not be used for prolonged periods because overuse can actually make nasal congestion worse. The NHS advises checking the product instructions or speaking to a pharmacist about appropriate use. How can Medical Specialists help? For many people, a pharmacist or GP can successfully manage hay fever. However, specialist medical help can be particularly valuable when symptoms are severe, persistent or difficult to control. A GP can review the diagnosis, check whether another condition could be contributing to the symptoms, prescribe appropriate medication where necessary and consider referral to a specialist. An allergy specialist can investigate exactly which allergen is causing the reaction and may arrange more detailed allergy testing. Specialists can also assess whether someone could benefit from allergen-specific immunotherapy, sometimes called desensitisation. Immunotherapy: treating the underlying allergy For selected people with severe hay fever that remains troublesome despite appropriate conventional treatment, specialists may consider allergen immunotherapy. Rather than simply treating the symptoms, immunotherapy aims to gradually change the body's response to the allergen by giving carefully controlled amounts of the relevant allergen over time. Depending on the specific treatment, this may involve injections or tablets placed under the tongue. NHS guidance explains that immunotherapy is a specialist treatment and is normally considered when other hay fever treatments have not provided sufficient control. NICE has also recommended certain specialist immunotherapy treatments for appropriately selected people with severe pollen allergies, including specific treatments for birch-pollen allergy. Reducing your exposure to pollen Medication is only part of managing hay fever. Reducing exposure can also help. Useful measures include:

• Check the daily pollen forecast.
• Keep windows closed when pollen levels are high, particularly if symptoms are severe.
• Wear wraparound sunglasses outdoors to reduce pollen reaching the eyes.
• Shower and change clothes after spending a lot of time outdoors.
• Wash hair regularly if you have been outside during high-pollen periods.
• Avoid drying clothes outside when pollen levels are high.
• Keep car windows closed and use the vehicle's pollen filter where available.
• Avoid cutting grass or spending prolonged periods around freshly cut grass if grass pollen triggers your symptoms.
• Keep indoor areas clean and consider a vacuum with a HEPA filter.
• Avoid bringing unnecessary pollen into the bedroom.

When should you see a doctor? You should consider speaking to a GP if:

• Your symptoms are becoming increasingly severe.
• Pharmacy treatments are not controlling your symptoms.
• Hay fever is affecting your sleep, work, school or everyday activities.
• You are unsure whether your symptoms are actually caused by hay fever.
• You experience significant wheezing, coughing, breathlessness or worsening asthma symptoms.
• You would like to discuss specialist allergy testing or immunotherapy.

A specialist referral may be appropriate when the diagnosis is uncertain, the responsible allergen cannot be established, or symptoms remain severe despite treatment. Conclusion Hay fever can be far more than an occasional bout of sneezing. During periods of warm, dry or windy weather, pollen can become a major problem for susceptible people, and symptoms can become severe enough to interfere with everyday life. The good news is that there is a wide range of treatments available. Antihistamines, steroid nasal sprays, eye drops and saline treatments can provide effective symptom control, while GPs and allergy specialists can assess people whose symptoms are more difficult to manage. For selected patients with severe allergies, specialist immunotherapy may provide a longer-term approach to reducing the body's reaction to specific pollen allergens. If hay fever is becoming difficult to control, there is no need to simply put up with it. A pharmacist, GP or allergy specialist can help identify the most appropriate combination of treatments and develop a plan to make the pollen season much more manageable.